Nearly 800 overdose deaths in the first half of the year linked to the powerful synthetic opioid fentanyl helped push the number of overdose deaths in Maryland to a new high, state data released Tuesday shows.
While the number of deaths from heroin and opioids generally moderated slightly, fentanyl-related fatalities jumped 70 percent over the same six-month period last year.
Authorities have struggled to respond to the increasing presence of the cheap drug, which is often mixed with heroin — and occasionally even cocaine and marijuana — and unrecognizable to users who are unaccustomed to its potency. Fentanyl is 50 to 100 times more powerful than heroin.
As fentanyl deaths soar, an even more powerful opioid, carfentanil, is starting to register in the data from the state Department of Health. There were 46 related deaths in the first half of the year, according to the report.
“Maryland is continuing to combat this crisis — including the increasingly deadly threat posed by fentanyl and carfentanil, with everything we’ve got, and we see a significant amount of work being done at the state and local level each day,” said Clay Stamp, executive director of the state’s Opioid Operational Command Center. “It will take everyone working together — from the federal, state, and local levels — to turn the tide in this epidemic and save the lives of thousands of Marylanders.”
Gov. Larry Hogan created the command center earlier this year to coordinate the state’s response to the growing opioid crisis.
Katie Kuehn, a spokeswoman for the center, said it will be an “all-hands-on-deck” nationwide effort with the federal government supporting states' efforts at prevention, enforcement, and treatment to combat the opioid epidemic.
The state reported a total of 1,172 deaths from alcohol or drug intoxication statewide in the first half of the year, with 799 related to fentanyl.
Maryland is on pace to surpass last year’s record of 2,089 overdose deaths with 1,119 related to fentanyl.
The data show that heroin-related deaths appear to have stabilized in the first half of this year at 586, up just 7 from last year.
But other drugs appear to be making a comeback, like cocaine, or making a deadly debut, like carfentanil.
Screening for carfentanil began last year in state labs, and officials found none of the drug, considered far more powerful than fentanyl and used as a elephant tranquilizer. Officials began reporting deaths from the drug in April.
Cocaine jumped for the third straight year with 49 related deaths statewide in the first six months. The number jumped to 276 when that drug was found in combination with opioids.
Baltimore City had the most deaths from drugs and alcohol — 393 so far this year, up from 304 in the same period last year.
The next highest numbers of deaths in the first half of the year were recorded in the counties of Baltimore (187), Anne Arundel (111) and Prince George’s (85). Harford logged 52, Howard saw 31 and Carroll reported 29.
Seven of 24 Maryland jurisdictions saw a drop in deaths, mostly rural counties that have far smaller numbers to count.
“It’s a problem everywhere,” said Dr. Leana Wen, Baltimore City health commissioner. “But we have to recognize here in Baltimore people have been addicted to heroin and opioids for decades. Individuals have not had access to treatment for many years, and many of these individuals are using drugs when we now have fentanyl.”
Just a small amount can suppress breathing quickly and lead to death.
Wen has been working actively to expand access to treatment and warn users in real time through text messages of a so-called bad batch nearby that may contain fentanyl so people can steer away. Authorities have said, however, that some users seek out more powerful drugs for a stronger high, something Wen works to counter by not providing specific addresses.
She said if she had more resources, she’d continue to expand access to treatment, make the overdose drug naloxone more widely available and press law enforcement and doctors to reduce the flow of opioids such as the prescription painkillers with which many users get their start.
Congress is considering several measures, including legislation to give better technology to U.S. Customs and Border Control to screen for fentanyl and other drugs that largely come from China, as well as a bill that would require the U.S. Postal Service to collect electronic data on shipments so suspicious packages can more easily be flagged.
State and local police, along with the U.S. Drug Enforcement Administration, continue to make arrests and work to determine where the drugs come from.
In August, President Donald Trump first brought up the prospect of declaring a national emergency that could free up resources to tackle the opioid crisis.
“I‘m saying officially right now it is an emergency,” Trump said at the time. He brought up the issue again last week, saying he’d make the formal declaration this week.
The Morning Sun
Meanwhile, state health officials say they will continue expanding their efforts, which have included broadening access to health care through the federal-state Medicaid program for low-income residents so they qualify for treatment and a hotline for users seeking aid.
“We continue to see a dramatic increase in the number of overdose deaths connected to fentanyl, and the Maryland Department of Health is committed to building a continuum of care for those with substance use disorders,” said Dennis Schrader, acting health secretary, in a statement.
The issue is not that state and local officials are not trying to curb overdose deaths, but there are many hurdles, said Dr. Christopher Welsh, and addiction specialist and medical director of the University of Maryland Medical Center Comprehensive Recovery Program.
He said the economy remains weak, particularly in some rural and urban communities, leaving people to turn to drugs and alcohol. Some with addiction problems are homeless or not in stable homes, complicating treatment efforts. And fentanyl poses even tougher challenges because many people don’t know what they are getting, said Welsh, also an associate professor of psychiatry at the University of Maryland School of Medicine.
Some people who come into the hospital’s emergency room have used cocaine or even marijuana laced with fentanyl without their knowledge, he said.
Welsh said expanding treatment availability will help. Several hospital emergency departments now offer overdose victims a first dose of the treatment drug buprenorphine as well as a referral to a community treatment program, he said. Some city doctors are prescribing buprenorphine via tele-medicine to more rural areas where there are not enough providers or the doctors limit their practices by only taking cash, for example. The emergency physicians also are offering naloxone to users and family members.
“It’s frustrating when we see the [overdose] numbers go up and everyone is trying,” he said. “Just throwing money at the problem won’t help; we have larger economic and societal issues to grapple with.”